=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407565278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HYGENERATE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2022
-----------------------------------------------------
Last Update Date | 06/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 WALL ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27565-3255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-339-1641
-----------------------------------------------------
Fax | 984-464-7709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11845 RETAIL DR # 1111
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-7352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-599-4452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JULIANNE TONDREAU
-----------------------------------------------------
Credential | DNP, APRN, FNP-BC
-----------------------------------------------------
Telephone | 919-599-4452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------